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* 1. What are your childcare needs with the closure of area schools until May 15?

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* 2. If schools closed for the rest of the school year, what would your childcare needs be? Answer if different from response in #1.

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* 3. Please type the age of each child needing care in the corresponding box.

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* 4. Can your job be performed remotely?

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* 5. If you can perform your job remotely, have you already received permission to work from home?

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* 6. Please list your:

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* 7. Are there current barriers to child care that you are willing to share?  Check all that apply.

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